Gastrointestinal Complications (PDQ®): Supportive care - Health Professional Information [NCI] - Radiation Enteritis
Surgery should be undertaken only after careful assessment of the patient's clinical condition and extent of radiation damage because wound healing is often delayed, necessitating prolonged parenteral feeding after surgery. Even after apparently successful operations, symptoms may persist in a significant proportion of patients.
Treatment techniques that can minimize the risk of severe radiation enteritis include the following:
- Radiation therapy techniques, including the following:
- The use of a three- or four-field technique (as opposed to a two-field technique) to minimize the amount of small bowel exposed to treatment.
- The treatment of the patient in a physical position that will aid in removing as much small bowel from the treatment field as possible (e.g., treating a patient with a full bladder each day to aid in pushing the small bowel up and out of the pelvis when pelvic radiation is given).
- Daily treatment of all fields, resulting in a lower integral dose and more homogenous dose distribution.
- Use of computerized radiation dosimetry to best design the treatment plan and the use of high-energy treatment machines such as linear accelerators that deliver a high dose-to-tumor volume while sparing the normal structures.
- Surgery. Placing clips in high-risk areas to better define the location or former location of the tumor and aid in radiation treatment planning.
- Modification of treatment sequencing. An area for exploration is the sequencing of radiation, chemotherapy, and surgery and its influence on the severity of enteritis.
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